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Predicting surgical site infections following laparoscopic bariatric surgery: development of the BariWound tool using the MBSAQIP database

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although bariatric surgery is a safe procedure for severe obesity, incisional surgical site infections (SSI) remain a significant cause of morbidity. Bariatric surgery patients are at high risk due to obesity and diabetes. The objective of this study was to develop a predictive tool for incisional SSI within 30 days of bariatric surgery.

Methods

Data were retrieved from the 2015 and 2016 MBSAQIP databases. This study included patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). The primary outcome of interest was incisional SSI occurring within 30 days. Surgeries performed in 2015 were used in a derivation cohort and the predictive tool was validated against the 2016 cohort. A forward selection algorithm was used to build a logistic regression model predicting probability of SSI.

Results

A total of 274,187 patients were included with 71.7% being LSG and 28.3% LRYGB. 0.7% of patients had a SSI in which 71.0% had an incisional SSI, and 29.9% had an organ/space SSI. Of patients who had an incisional SSI, 88.7% were superficial, 10.9% were deep, and 0.4% were both. A prediction model to assess for risk of incisional SSI, BariWound, was derived and validated. BariWound consists of procedure type, chronic steroid or immunosuppressant use, gastroesophageal reflux disease, obstructive sleep apnea, sex, type 2 diabetes, hypertension, operative time, and body mass index. It stratifies individuals into very high (> 10%), high (5–10%), medium (1–5%), and low risk (< 1%) groups. This model accurately predicted events in the validation cohort with an area under the receiver operating characteristic curve of 0.73.

Conclusions

BariWound accurately predicted the risk of 30-day incisional SSI in individuals undergoing bariatric surgery. Stratifying low- and high-risk groups allows for customized SSI prophylactic measures for patients in various risk categories and potentially enables future research targeted at high-risk patients.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Jerry T. Dang, Michael Laffin, Daniel W. Birch & Shahzeer Karmali

  2. Centre for the Advancement of Surgical Education and Simulation, Edmonton, AB, Canada

    Caroline Tran

  3. Ohio State University, Columbus, OH, USA

    Noah Switzer

  4. Department of Surgery, University of Manitoba, Winnipeg, MB, Canada

    Megan Delisle

  5. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Karen Madsen

  6. Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Jerry T. Dang

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Correspondence to Jerry T. Dang.

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Jerry T. Dang, Caroline Tran, Noah Switzer, Megan Delisle, Michael Laffin, Karen Madsen, Daniel W. Birch, and Shahzeer Karmali have no conflicts of interest or financial ties to disclose.

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Appendix: definitions

Appendix: definitions

Variable name: superficial incisional SSI


Intent of variable To capture the occurrence of infection that does not meet the more severe criteria of deep incisional SSI or organ/space SSI.


Definition Superficial incisional SSI is an infection that involves only skin or subcutaneous tissue of the surgical incision.


Criteria An infection that occurs within 30 days after the principal operative procedure AND the infection involves only skin or subcutaneous tissue of the incision AND at least ONE of the following:

  1. A.

    Purulent drainage, with or without laboratory confirmation, from the superficial incision.

  2. B.

    Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.

  3. C.

    Superficial incision is deliberately opened by the surgeon (see note below)

AND


At least one of the following signs or symptoms of infection:

  • pain or tenderness

  • localized swelling

  • redness

  • heat

If the patient meets criterion C and the surgical incision is cultured, a negative culture result would exclude the assignment of Superficial SSI based on criterion C only.

  1. D.

    Diagnosis of superficial incisional SSI by the surgeon or attending physician.

Variable name: deep incisional SSI


Intent of variable To capture the occurrence of infection that does not meet the criteria of superficial incisional SSI or organ/space SSI. These infections are typically more severe than the superficial SSI category.


Definition Deep Incisional SSI is an infection which involves deep soft tissues. Deep soft tissues are typically any tissue beneath skin and immediate subcutaneous fat, for example fascial and muscle layers.


Criteria An infection that occurs at the surgical site within 30 days after the principal operative procedure AND involves deep soft tissues AND at least ONE of the following:

  1. A.

    Purulent drainage from the deep incision but not from the organ/space component of the surgical site.

  2. B.

    A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following signs or symptoms: fever (greater than 38 °C), localized pain, or tenderness, unless the site is culture-negative.

  3. C.

    An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiologic examination.

  4. D.

    Diagnosis of a deep incision SSI by a surgeon or attending physician.

Variable name: organ/space SSI


Intent of variable To capture the occurrence of infection that does not meet the criteria of superficial incisional SSI or deep incisional SSI. This category of infection is typically the most severe and is more likely to require procedural intervention.


Definition Organ/Space SSI is an infection that involves any part of the anatomy (e.g., organs or spaces), other than the incision, which was opened or manipulated during an operation.


Criteria An infection that occurs within 30 days after the principal operative procedure AND involves any of the anatomy (e.g., organs or spaces), other than the incision, which was opened or manipulated during the operation AND at least ONE of the following:

  1. A.

    Purulent drainage from a drain that is placed through a stab wound into the organ/space. This does not apply to drains placed during the principal operative procedure, which are continually in place, with continual evidence of drainage/infection since the time of the principal operative procedure.

  2. B.

    Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space.

  3. C.

    An abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination.

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Dang, J.T., Tran, C., Switzer, N. et al. Predicting surgical site infections following laparoscopic bariatric surgery: development of the BariWound tool using the MBSAQIP database. Surg Endosc 34, 1802–1811 (2020). https://doi.org/10.1007/s00464-019-06932-6

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